Healthcare Provider Details

I. General information

NPI: 1063835676
Provider Name (Legal Business Name): MICAH CRAWFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S MCCLINTOCK DR STE 105
TEMPE AZ
85282-2692
US

IV. Provider business mailing address

1400 E SOUTHERN AVE STE 735
TEMPE AZ
85282-5699
US

V. Phone/Fax

Practice location:
  • Phone: 480-804-0326
  • Fax: 480-804-0083
Mailing address:
  • Phone: 480-804-0326
  • Fax: 480-804-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0161511
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11282
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: